Annals of Occupational and Environmental Medicine

Brief communication

Workers' opinions on working time regulations: results from the 5th Korean Work, Sleep, and Health Study (KWSHS): Jeong Woo Park, Seong-Sik Cho, Mo-Yeol Kang, Min Choi, Jongwoo Lee; Ann Occup Environ Med 2026;e32. Published online July 21, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e32 [Accepted]

Abstract PDF: Although South Korea's average annual working hours have declined over recent decades, the country continues to rank higher among Organisation for Economic Co-operation and Development countries. Despite ongoing policy debates on working time reform, public perspectives on specific regulatory measures among Korean workers remain underexplored. This study analyzed data from the 5th wave of the Korean Work, Sleep, and Health Study (KWSHS). The survey was conducted in September 2024 via an online platform. A total of 5,783 working adults aged 19–70 years were included. Participants were asked about their opinions on five working time regulatory measures, including the current weekly hour cap, extending regulations to small companies and exempt industries, introducing a daily working hours limit, regulating non-essential night work, and restricting weekend work for large supermarkets. A majority of respondents supported all five proposed regulatory measures. Support was highest for introducing a daily working hours cap (72.1% agree or strongly agree), followed by regulating non-essential night work (63.2%), extending the cap to small companies (60.1%), restricting weekend work for large supermarkets (60.7%), and introducing the weekly cap for exempt industries (52.8%). While 34.7% favored reducing the current weekly maximum, 36.5% preferred maintaining the current limit. The survey respondents generally support strengthening working-time regulations. These findings provide workers’ opinions on working-time regulations, although they should be interpreted within the study's limitations (a sample with a higher proportion of office workers).

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Original article

Psychometric validation of brief scales for loneliness at work in Korea: the Three-Item Scale for Loneliness at Work (SLAW-3) and Single-Item Scale for Loneliness at Work (SLAW-1): Ganguk Lee, Chunhui Suh, Seongdong Lee, Norito Kawakami; Ann Occup Environ Med 2026;e33. Published online July 24, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e33 [Accepted]

Abstract PDF: Background
Workplace loneliness is an emerging psychosocial risk factor in the occupational health context, but comprehensive assessment instruments are often impractical if large workforce surveys are planned. This study evaluated the measurement properties of two brief workplace loneliness indicators: the Single-Item Scale for Loneliness at Work (SLAW-1) and the Three-Item Scale for Loneliness at Work (SLAW-3).
Methods
Data were obtained from a nationwide online survey of Korean employees (n = 1,000), with proportional sampling by sex, age, and occupation. A subsample (n = 200) underwent 4-week follow-up to assess test–retest reliability. Internal consistency and confirmatory factor analysis were examined for SLAW-3, whereas test–retest reliability was assessed for SLAW-1. Criterion validity was tested against a single-item measure of general loneliness. Convergent validity was examined by deriving correlations with occupational stress and psychological distress, work performance, work engagement, and well-being.
Results
SLAW-3 demonstrated acceptable internal consistency (α = 0.883) and was consistent with a single-factor interpretation. SLAW-1 exhibited moderate 4-week test–retest reliability (r = 0.603). Both scales were associated with workplace loneliness and related psychological and occupational variables, in the expected directions. SLAW-1 was more strongly related to general loneliness, whereas SLAW-3 evidenced stronger associations with workplace loneliness.
Conclusions
SLAW-1 and SLAW-3 appear to be practical brief indicators of workplace loneliness. SLAW-1 may be appropriate for rapid screening, whereas SLAW-3 offers a more context-specific assessment in terms of occupational health research and monitoring.

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Original article

The association between commute time and both presenteeism and absenteeism: a cross-sectional analysis of the 6th Korean Working Conditions Survey: Tae Jin Ahn, Young-Sun Min, Soon-Chan Kwon, Jisuk Yun, Sang-Ho Oh, Eun-Chul Jang; Ann Occup Environ Med 2026;e31. Published online July 21, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e31 [Accepted]

Abstract PDF: Background
This study examined whether longer commute time is associated with presenteeism and absenteeism among Korean wage workers, in the context of Korea’s comparatively long commutes and growing concerns about work-related productivity loss in an increasingly urbanized society.
Methods
We analyzed 28,349 wage workers from the 6th Korean Working Conditions Survey, excluding individuals younger than 20 years, foreign nationals, telecommuters, self-employed workers, unpaid family workers, and those with missing or incomplete data. Commute time was categorized into ≤60, 61–120, and ≥121 minutes per day. Presenteeism was defined as having worked while sick in the past 12 months (or since starting the current job), and absenteeism as having at least one day of sickness-related absence during the same period. Sex-stratified, survey-weighted multiple logistic regression analyses were performed to estimate odds ratios and 95% confidence intervals while accounting for the complex survey design.
Results
Overall, 82.1% of workers reported commuting ≤60 minutes, 11.2% reported presenteeism, and 3.9% reported absenteeism. Among men, commute times of 61–120 and ≥121 minutes were associated with higher odds of presenteeism, and ≥121 minutes with higher odds of absenteeism compared with ≤60 minutes. Among women, commute times of 61–120 and ≥121 minutes were associated with higher odds of presenteeism, and ≥121 minutes with higher odds of absenteeism, indicating a similar but slightly more pronounced pattern.
Conclusions
Longer commute times were associated with increased odds of both presenteeism and absenteeism among Korean wage workers. In particular, women with commute times of ≥121 minutes showed higher odds of presenteeism than men. Commute time should be recognized as a modifiable factor relevant to occupational health in workplace and public policy, and further longitudinal research is needed to clarify causal pathways and to inform targeted interventions aimed at reducing commuting-related productivity loss.

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Original Article

The relations among workplace verbal abuse, job stress, and good self-rated health among Korean wage workers: Evidence from the 7th Korean Working Conditions Survey (KWCS): Youngdo Kim, Jung Wook Kim, Jung Ho Yang; Ann Occup Environ Med 2026;e29. Published online July 14, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e29 [Accepted]

Abstract PDF Supplementary Material: Background
Workplace verbal abuse has increasingly been recognized as a psychosocial hazard affecting employees’ health. Although its direct psychological consequences have been well documented, the mechanisms through which verbal abuse shapes employees’ self-rated health have been less thoroughly examined. In particular, limited empirical attention has been given to the mediating role of job stress in this relationship. The association between workplace verbal abuse and good self-rated health among Korean wage workers was investigated, and the mediating role of job stress in this relationship was further examined.
Methods
Data were drawn from the 7th Korean Working Conditions Survey (KWCS), which included a nationally representative sample of 26,427 wage workers aged 20 years or older. Verbal abuse, job stress, and good self-rated health were assessed using structured self-report items. Multivariable logistic regression analyses were performed to evaluate associations among verbal abuse, job stress, and good self-rated health, with adjustments made for individual- and occupational/workplace-related covariates.
Results
Workplace verbal abuse was significantly associated with higher odds of job stress (odds ratio [OR]: 1.527; 95% confidence interval [CI]: 1.300–1.803; p < 0.001) and lower odds of good self-rated health (OR: 0.641; 95% CI: 0.566–0.726; p < 0.001). Mediation analysis indicated that job stress partially mediated the relationship between verbal abuse and good self-rated health, accounting for 2.38% of the total effect (indirect effect: –0.0021; p < 0.001), while the direct effect of verbal abuse remained significant.
Conclusion
Workplace verbal abuse was associated with poorer good self-rated health, both directly and indirectly through job stress. These findings highlight the need for organizational interventions and policy-level strategies aimed at reducing verbal aggression and mitigating occupational stress.

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Original Article

Association between workplace cooperation and depressive symptoms differs according to employment type: the seventh Korean Working Conditions Survey: Jung Wook Kim, Youngdo Kim, Jung Ho Yang; Ann Occup Environ Med 2026;e30. Published online July 14, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e30 [Accepted]

Abstract PDF Supplementary Material: Background
The relationship between workplace cooperation and mental health has gained increasing attention. However, the extent to which employment type moderates the association between workplace cooperation and depressive symptoms remains underexplored. The present study aimed to investigate the association between workplace cooperation, depressive symptoms, and employment type among South Korean wage workers.
Methods
The present work analyzed data from the seventh Korean Working Conditions Survey (KWCS), including 25,259 wage workers aged 20 years and older. Employment type was categorized as one of regular-, temporary-, or daily laborer. Workplace cooperation was assessed using a five-point Likert scale item regarding cooperation among colleagues. Depressive symptoms were measured using the World Health Organization (WHO)-5 Well-Being Index. Multivariable logistic and linear regression analyses were conducted to evaluate the association between workplace cooperation and depressive symptoms or the WHO-5 Well-Being Index.
Results
Cooperation was significantly associated with lower odds of depressive symptoms in regular workers (odds ratio [OR]: 0.538; 95% confidence interval [CI]: 0.498–0.581), temporary workers (OR: 0.666; 95% CI: 0.561–0.790), and daily laborers (OR: 0.479; 95% CI: 0.339–0.679). The association between workplace cooperation and depressive symptoms differed significantly by employment type (interaction p = 0.016 for temporary vs. regular workers): the inverse association was weaker among temporary workers than among regular workers (interaction OR: 1.261; 95% CI: 1.045–1.522), whereas no significant difference was observed between regular workers and daily laborers (interaction OR: 0.912; 95% CI: 0.651–1.279; p = 0.595).
Conclusion
Workplace cooperation was significantly associated with lower odds of depressive symptoms across all employment types, but the magnitude of this protection varies significantly by employment status.

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Original Article

Relationship between shark meat intake and blood mercury concentration in Korean adolescents: Jeong A Chang, Jeong woo Park, Joon SaKong; Ann Occup Environ Med 2026;e28. Published online July 13, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e28 [Accepted]

Abstract PDF: Background
Mercury exposure through seafood consumption poses health risks, yet limited research has examined shark meat—a large predatory fish still consumed in Korea—and its association with blood mercury levels in adolescents.
Methods
This cross-sectional study used data from the 3rd Korean National Environmental Health Survey (KNEHS). Multiple linear and logistic regression analyses were performed to assess the association between shark meat intake and blood mercury levels and to estimate the odds ratios for exceeding the reference blood mercury level, adjusting for potential confounders.
Results
Of the 912 participants, 50 (5.5%) were identified as shark meat consumption group. Shark meat consumption was associated with higher blood mercury concentrations (β = 0.41; 95% confidence interval [CI]: 0.23–0.59), with the highest levels observed among those who consumed shark meat within the past 30 days (β = 1.19; 95% CI: 0.30–2.08), those who preferred shark meat (β = 0.67; 95% CI: 0.26–1.08), and those with higher annual intake (β = 0.71; 95% CI: 0.00–1.43). Shark meat consumers had substantially higher odds of exceeding the blood mercury reference level (≥5.8 µg/L; odds ratios: 35.84; 95% CI: 3.39–378.84), with an estimated attributable risk of 97.2% (95% CI: 70.5%–99.7%) and a population attributable risk of 65.7% (95% CI: 11.6%–95.4%). Of the estimated 25,740 (95% range: 11,905–54,913) adolescents aged 12–17 years potentially exceeding this threshold, approximately 16,911 (95% CI: 2,986–24,556) cases may be attributable to shark meat consumption, though these estimates should be interpreted cautiously given the wide confidence intervals.
Conclusion
Shark meat consumption was associated with elevated blood mercury levels in Korean adolescents. Targeted education on its potential health risks is needed to reduce unintended exposure, while maintaining the nutritional benefits of fish consumption.

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Original Article

Association between shift work patterns and the incidence of prediabetes and diabetes among night shift workers: a retrospective cohort study: Hyundong Lee, Changil Shin, Minsun Kang, Jae Bum Park, Inchul Jeong, Jaehyuk Jung; Ann Occup Environ Med 2026;e26. Published online July 9, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e26 [Accepted]

Abstract PDF: Background
Prediabetes and diabetes represent major public health challenges, and shift work has been identified as a significant occupational risk factor. While two-shift systems are gaining preference over conventional three-shift systems, evidence comparing their risks for diabetes and prediabetes remains limited. We aimed to evaluate the risk of developing prediabetes and diabetes according to shift work patterns among night shift workers. Methods: This retrospective cohort study analyzed 14,879 night shift workers at a tertiary hospital in Korea (2016–2022). Participants were classified into two- and three-shift patterns. Incident diabetes and prediabetes were identified based on fasting blood glucose and hemoglobin A1c levels, diagnosis, or medication use. Data were censored at shift change, diagnosis, loss to follow-up, or the end of the study. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographics, lifestyle, body mass index, and occupational characteristics including working hours, consecutive night shifts, quick returns, and shift duration. Results: The two-shift group showed significantly higher incidence rates of diabetes and prediabetes than the three-shift group. After adjusting for covariates, two-shift work remained an independent risk factor for diabetes (adjusted HR: 1.43; 95% CI: 1.10–1.87) and prediabetes (adjusted HR: 1.34; 95% CI: 1.20–1.48). Stratified analyses indicated that the increased risk of diabetes associated with two-shift work was prominent in participants working 40 hours and 41–51 hours per week, whereas the association was not significant in those working ≥52 hours. Conclusions: Two-shift work was associated with a significantly higher risk of diabetes and prediabetes compared with three-shift work. Our findings highlight the need to consider specific shift schedules and their potential health effects when designing or selecting workforce systems, rather than focusing solely on productivity or preference.

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Original Article

Current status and demand projections for occupational and environmental medicine specialists: focus on special health examinations and outsourced occupational health management services: Hye-Eun Lee, Hee-Tae Kang, Mo-Yeol Kang, Chungwon Kang, Kyong Sok Shin, Hyeon-Taek Heo, Yong Lim Won, Jungwon Kim; Ann Occup Environ Med 2026;e23. Published online July 1, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e23 [Accepted]

Abstract PDF: Background
Occupational and environmental medicine (OEM) specialists are key personnel within the occupational health system. Recent developments, such as the introduction of the Serious Accidents Punishment Act and the expansion of occupational health policies targeting vulnerable workers, have highlighted the need to broaden the role of OEM specialists. This study analyzed the current workload of OEM specialists and projected their medium- to long-term demand.
Methods
The demand for OEM specialists was defined as the actual observed service utilization volume under the current legal, institutional, and policy environment. Key work areas were categorized as special health examinations and outsourced occupational health management services. Data sources included administrative records from the Korea Occupational Safety and Health Agency (KOSHA) and the Ministry of Employment and Labor (MoEL), statistics on worker health examination results, and evaluation data from specialized agencies for occupational health management. Demand through 2035 was projected by applying the observed historical growth trend in service utilization. The required number of specialists was calculated by applying the average workload per specialist in the base year.
Results
As of 2025, 577 OEM specialists were working at 255 special health examination institutions. Among the 153 occupational health management agencies, 265 physicians were employed, including 133 OEM specialists. The number of workers requiring services from OEM specialists is predicted to continue growing. Applying the current average workload per physician, an additional 132 special health examination physicians and 92 occupational health management agency physicians will be needed by 2035.
Conclusions
Actual workforce demand may differ from the projections presented in this study depending on changes in policies, industrial structure, service delivery models, and work efficiency. Future studies should incorporate need-based estimates that reflect the diverse roles of OEM specialists and use integrated workforce data to provide more refined projections.

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Original Article

Occupational determinants of national health screening participation: an analysis of the KNHANES (2007–2023): Chan Young Lee, Jun-Pyo Myong, Mo-Yeol Kang; Ann Occup Environ Med 2026;e22. Published online June 24, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e22 [Accepted]

Abstract PDF: Background
South Korea operates a national health screening program aimed at early detection of major diseases. Although participation rates have been linked to various socioeconomic and demographic factors, occupational determinants remain insufficiently characterized.
Methods
This study analyzed 37,987 employed wage earners from the Korea National Health and Nutrition Examination Survey conducted between 2007 and 2023. The primary outcome was self-reported health screening program participation within the preceding two years. Occupational characteristics—including classification of occupations, employment status, working hours, work arrangement, and supervisory role—as well as workplace conditions and hazard exposures were examined. Prevalence ratios (PRs) with 95% confidence intervals were calculated for each characteristic. Generalized additive models were used to examine the nonlinear association between weekly working hours and participation rates. Multivariable modified Poisson regression models incorporating interaction terms between occupational characteristics and survey year assessed temporal trends in participation disparities.
Results
The overall health examination rate was 71.32%. Compared with managers, all other occupational categories—except armed forces—had significantly lower PRs of participation, with sales workers showing the lowest. Temporary, daily, non-regular, and part-time workers showed significantly lower PRs. Those working less than 35 or more than 52 hours per week showed significantly lower PRs than the reference group (35–52 hours). An inverted U-shaped association was observed, with participation peaking at approximately 40–50 hours per week. Among workplace conditions, decision-making authority, working under time pressure, and physical hazard exposure were associated with higher participation, whereas prolonged uncomfortable postures and heavy material handling were associated with lower participation. Over the 17-year study period, the adjusted PRs for working hours showed no significant temporal change.
Conclusions
Significant occupational disparities in health screening participation exist among Korean wage earners. Targeted interventions addressing vulnerable occupational groups are warranted to reduce disparities and improve overall worker health outcomes.

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Original Article

Occupational differences in benzene-related biomarker levels beyond traditional industrial settings: findings from the Korean National Environmental Health Survey, 2015–2023: Chul Gab Lee; Ann Occup Environ Med 2026;e19. Published online June 15, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e19 [Accepted]

Abstract PDF: Background
Benzene is a group 1 carcinogen, and urinary trans, trans-muconic acid is a key biomarker of benzene exposure. Whether specific occupational groups in Korea have higher benzene body burdens beyond environmental levels has not been systematically evaluated using national biomonitoring data with smoking-adjusted biomarkers.
Methods
We pooled adult data from three cycles (3rd–5th) of the Korean National Environmental Health Survey (KoNEHS, 2015–2023; n = 10,786). Creatinine-adjusted urinary ttMA (UttMACr) was analyzed across nine occupation groups using complex-samples general linear models with nested covariates. Sampling weights were rescaled within each cycle to harmonize weight scales across waves. Smoking was controlled using questionnaire-based variables and five-level creatinine-adjusted urinary cotinine (COTCr). Variance decomposition quantified predictors' contributions, and sensitivity analyses included COTCr-stratified models and analyses limited to the economically active population.
Results
Population geometric mean UttMACr declined by 51% from the 3rd to 5th cycle, occupation remained a significant independent predictor after adjusting for temporal trends, smoking, demographic, and lifestyle covariates (ΔR² = 0.0018, p = 0.003). Cleaning/guard/elementary workers showed the highest elevation in the geometric mean ratio (GMR: 1.13; p < 0.001), followed by food/textile/other manufacturing (GMR: 1.12; p < 0.05) and chemical/metal/machinery manufacturing workers (GMR: 1.08; p < 0.05). COTCr-stratified analyses revealed occupation-specific patterns attenuated in pooled models: among participants with COTCr ≤ 1.0 μg/g creatinine, construction/mining (GMR: 1.62; p < 0.001) and agriculture/fishery (GMR: 1.41; p < 0.01) showed marked elevations.
Conclusions
Population UttMACr levels in Korea declined over time, but occupation-specific differences persisted after adjustment for trends, smoking, and sociodemographic factors. These findings suggest occupational benzene exposures may extend beyond traditionally recognized industrial settings and support more targeted biomonitoring, particularly for worker groups not routinely prioritized in current surveillance programs.

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Original Article

Evaluating the efficacy of prednisolone for silicosis with progressive massive fibrosis in Australia: an observational pilot study: Hayley Barnes, David P. Nadebaum, Daniel Niewodowski, J. K. Khoo, Yuan Z. Lim, Bradley Gardiner, Tiffany Lin, Martin Cherk, Miranda Siemienowicz, Jyotika D. Prasad, Ryan Hoy; Ann Occup Environ Med 2026;e16. Published online June 4, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e16 [Accepted]

Abstract PDF: Background
There has been a resurgence of silicosis, particularly related to artificial stone. There are currently no treatments for silicosis beyond lung transplantation for end-stage disease. To evaluate the efficacy of prednisolone in people with artificial stone-associated silicosis–progressive massive fibrosis (PMF).
Methods
This was a pilot prospective observational clinical trial, assessing 3 months of prednisolone in adults with artificial stone–associated silicosis with PMF. Outcomes were assessed at 3 and 12 months.
Results
Seven participants completed the study. Baseline positron emission tomography (PET) scans demonstrated increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in areas of PMF in all participants. All participants had a significant reduction in maximum standardized uptake value (SUVmax) following prednisolone at 3 months (pre-treatment mean SUVmax 6.7 [standard deviation (SD): 2.6], post-treatment mean SUVmax 4.2 [SD: 1.0], p = 0.01). There was also a non-significant reduction in the % of total lung parenchyma with SUV >1 (49.7% [SD: 36.4] to 45.8% [SD: 28.4], p = 0.52) and a significant reduction in SUV >2.5 (7.0% [SD: 6.3] to 2.4% [SD: 2.2], p = 0.03). There was a non-significant reduction in computed tomography ICOERD well-defined opacity profusion scores and large opacities. There was no significant difference in lung function or St. George's Respiratory Questionnaire. There were no serious adverse events.
Conclusions
There are high levels of inflammation in silicosis-PMF as evidenced by 18F-FDG PET. Short-term prednisolone reduced 18F-FDG PET activity. This suggests a possible therapeutic pathway for people with silicosis-associated PMF in a population with no current treatments. Further research is required to determine the most appropriate immunosuppressive strategy and further assess longer-term outcomes.

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Case Report

Sinonasal hemangiosarcoma following juvenile occupational exposure to formaldehyde when breeding farm animals: Daniela Napolitano, Stefania Massacesi, Roberto Calisti; Ann Occup Environ Med 2026;e27. Published online July 13, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e27 [Accepted]

Abstract PDF: Background
Hemangiosarcomas are heterogeneous malignancies possibly originating in any part of the body, rare in humans. The web of causation of human hemangiosarcomas remains poorly understood, to date, except for subsets of cases which have been recognized in a well-defined causal correlation to vinyl chloride or to ionizing radiation. In 2005, the International Agency for Research on Cancer ranked formaldehyde as a human carcinogen, causally related to both nasopharyngeal cancers and acute non-lymphocytic leukemias; at the time, the evidence in favor of a causal relationship of formaldehyde to sinonasal cancers was stated as “limited”. In 2024, an umbrella review reported a significantly increased risk for sinonasal cancers among formaldehyde-exposed workers.
Case presentation
A sinonasal hemangiosarcoma affecting an Italian male born in 1957, diagnosed in 2022, was reported to the Italian National Registry of Sino-Nasal Cancers (ReNaTuNS); the patient’s occupational history revealed a remote exposure to formaldehyde, used as a disinfectant, when breeding farm animals, from 1967 to 1976. No previous reporting has been found about a possible association between formaldehyde and sinonasal non-epithelial cancers.
Conclusions
Formaldehyde is, in our opinion, a suitable candidate to be considered for playing a causal role in the causation of the neoplasm; formal studies are required to test the hypothesis.

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Case Report

Basal cell carcinoma and squamous cell carcinoma of the hands in an orthopedic surgeon with occupational radiation exposure from C-arm fluoroscopy in Korea: a case report: Jisue Yoon, Jihye Lee, Seongjin Jeong, Sangchul Roh, Min-Gi Kim, Jeongbae Rhie; Ann Occup Environ Med 2026;e25. Published online July 7, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e25 [Accepted]

Abstract PDF: Background
Occupational radiation exposure among medical professionals who use fluoroscopic devices is a well-recognized concern. While radiation-induced skin cancer has been reported in interventional radiologists, cases involving orthopedic surgeons with prolonged C-arm fluoroscopy exposure have rarely been described. We present a case of an orthopedic surgeon who developed basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on the hands after approximately 30 years of occupational radiation exposure from C-arm use during orthopedic surgeries in Korea.
Case presentation
A 62-year-old male orthopedic surgeon who performed C-arm fluoroscopy-assisted surgeries for 30 years without radiation-protective gloves presented with bleeding and skin lesions on his left hand. Hospital records documented an average of 314 C-arm-assisted surgeries per year with an estimated annual C-arm usage of 12,397 minutes. An on-site radiation assessment was conducted in the actual operating room using a simulated patient, with positioning replicated via structured interview. Measurements using an X/gamma survey meter at the surgeon's hand position yielded mean equivalent dose rate of 3.5 mSv/h and a maximum of 5.0 mSv/h, corresponding to estimated annual equivalent doses of 723 and 1,033 mSv/y, both exceeding the regulatory equivalent dose limit for extremities in Korea. The patient had experienced recurrent blistering on both hands for approximately 10 years. Biopsy revealed BCC on the left thumb and SCC on the left second and third fingers, with bilateral chronic radiation dermatitis. Excision and skin grafting were performed on the affected fingers.
Conclusions
This case demonstrates that prolonged C-arm fluoroscopy exposure without adequate hand protection can lead to radiation-induced skin cancers in orthopedic surgeons. The marked discrepancy between trunk-mounted dosimeter readings and estimated hand doses underscores the need for extremity-specific dosimetry. Radiation-protective gloves and regular dermatologic surveillance are essential for medical professionals exposed to ionizing radiation during fluoroscopy-guided procedures.

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Case Report

Recurrent laryngeal leukoplakia in a cook occupationally exposed to cooking oil fumes: a case report: Kyung-Eun Lee, Seong Won Ma, Jiwoon Kwon, Young Shin Lee, Shinhee Ye; Ann Occup Environ Med 2026;e24. Published online July 1, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e24 [Accepted]

Abstract PDF: Background
This study reports a case of recurrent laryngeal leukoplakia, a precancerous lesion, in a female cook with long-term occupational exposure to cooking oil fumes. In 2022, the Korean Epidemiological Investigation Evaluation Committee determined that substantial scientific evidence supported the work-relatedness of the case.
Case presentation
A 55-year-old woman working as a cook in group-catering facilities in long-term care hospitals and general hospitals was referred to an otolaryngology clinic after an abnormal laryngeal finding was incidentally detected during routine upper gastrointestinal endoscopy in April 2018. Subsequent laryngoscopy revealed granulation tissue of the left vocal fold. Histopathological examination following laryngeal microsurgery confirmed high-grade dysplasia, leading to a diagnosis of left vocal fold leukoplakia, and the lesion was excised. During follow-up, persistent voice changes and recurrence of the lesion were identified, and repeat excision again demonstrated low- and high-grade dysplasia. The patient had worked as a cook for approximately 14.6 years and routinely performed oil-intensive cooking tasks, including frying, grilling, stir-frying, and battered-dish preparation, for approximately 2–4.5 hours per day. She reported insufficient ventilation during heavy fume generation. She had no history of smoking, passive smoking from her spouse, alcohol consumption, vocal abuse, gastroesophageal reflux disease, or mechanical trauma to the larynx.
Conclusions
This case suggests a possible occupational contribution of repeated intermittent exposure to cooking oil fumes and irritant aldehydes to recurrent laryngeal precancerous lesions among cooks. However, because direct historical exposure measurements were unavailable and this is a single case report, definitive causality cannot be established. Improvement of workplace ventilation and other exposure-control measures should be considered, and further studies with direct exposure assessment are needed.

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